Risk of graft loss: single-factor and multifactor analysis in kidney transplantation from expanded criteria donors

Objective: to identify donor and recipient factors associated with the risk of loss of graft function in recipients of kidney grafts from expanded-criteria, brain-dead donors.

Materials and methods. A retrospective multicenter cohort study included 254 donors who met the UNOS expanded-criteria defi nition and 444 corresponding recipients. Donor and recipient characteristics, perioperative parameters, and post-transplant outcomes were analyzed using single- and multivariable Cox regression models.

Results. Mean donor age was 58.3 ± 4.8 years, and median cold ischemia time was 14.4 [12.3–17.0] hours. Mean recipient age was 51.6 ± 9.6 years. Class I antihuman leukocyte antigen (anti-HLA) antibodies (mean fl uorescence intensity [MFI] >500) were detected in 40 (9.2%) recipients, and class II antibodies in 56 (12.8%). Delayed graft function occurred in 34.3% of recipients. Multivariate analysis revealed that lower donor minimum glomerular filtration rate (GFR) (HR = 0.98; 95% CI 0.965–0.997; p = 0.023) and higher combined donor ALT + AST levels (HR = 1.208; 95% CI 1.063–1.372; p = 0.004) were signifi cantly associated with an increased risk of graft loss. Donor age was not a significant predictor. Among recipient factors, diabetes mellitus with target-organ damage (HR = 3.727; 95% CI 1.380–10.07; p = 0.009), nephropathy of unknown origin (HR = 3.816; 95% CI 1.212–12.02; p = 0.022), and elevated class II antiHLA antibody levels (HR = 1.125 per 1000 MFI; 95% CI 1.039–1.218; p = 0.004) were the strongest predictors of graft loss. When recipient GFR at three months post-transplant was included in the model, the signifi cance of donor-related factors (GFR, ALT, AST) was negated.

Conclusion. Recipient-related predictors of graft loss are diabetes mellitus, unknown etiology of initial CKD, high class II anti-HLA antibody levels, and reduced GFR at three months post-transplant. Donor-related predictors of graft loss are minimum GFR during the entire period of donor hospitalization and elevated ALT/AST levels; however, these factors become statistically insignificant when recipient GFR three months after KT is included in the model. 

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